Amarin Corp Plc (AMRN)

[rosemountbomber]

As Capt pointed out, EE forms of EPA are poorest at absorption, but it has to be stated that that comparison with other forms of EPA happens at a fasted state. When taken with fat the absorptions of the various forms of EPA become quite similar:

"Fasted State versus Fed State

An important finding in the majority of studies trying to understand the absorption behavior of omega-3 ethyl ester (EE) was that it is of utmost importance to take the omega-3-EE medication after a fatty meal (fed state) and not on empty stomach (fasted state). Unfortunately this fact is not detectable from the data shown in Table 2 because the Relative Bioavailability Index for the EE-form was always set to 100, even if the bioavailability with respect to absorbed absolute quantity of omega-3 (in mg) was very poor. A good illustration of this food effect can be seen in the absorption charts from the ECLIPSE study [18] where the bioavailability between an omega-3-ethyl ester drug (EE) and a omega-3-free-fatty-acid drug (FFA) was compared. The total EPA and DHA content of both drugs are comparable. From Figure 5a can be seen that the EE formulation (green line) in the fasted state (low fat diet) is only very poorly absorbed. Whereas the FFA form gets well absorbed with a typical Cmax at approx. 5 hours after intake. Taking the same formulations after a high fat diet (fed state) the absorption behavior of the EE improves dramatically and shows a similar curve-shape than the FFA-form (Figure 5b). However, looking at the total EPA+DHA plasma concentrations of the two charts (Y-Axis), it also becomes clear that the absolute quantity of absorbed EPA-FFA and DHA-FAA (in mmol/ml blood) improves almost twofold when the drug is taken after a fatty meal.




Therefore, in order to maximize the absolute quantity of EPA+DHA absorbed into the blood one should always ingest the omega-3 nutritional supplement or pharmaceutical drugs together or shortly after a fatty meal. Our digestive system, in particular the pancreatic enzymes and bile acids need to be triggered and released by a minimum amount of fat in our diet. This is especially important for the omega-3 EE form. Taking such a supplement or drug before or after a light breakfast (for example only fruit and coffee) will not release any pancreatic lipase that can split the EE into the absorbable FFA form. The majority of the ingested omega-3-EE will thus not be able to be absorbed and are lost with the feces. On the other hand, products offered as TG or rTG start to provoke a pancreatic response even in a fasted state and thus can be absorbed after being converted to the FFA and monoglyceride form. The efficiency of this “lipid digestion” can be even more improved by taking the TG/rTG omega-3 together with a fatty meal. In this case a maximum pancreatic lipase activity can be achieved which maximizes the efficiency of transforming EPA/DHA-rTG into the bioabsorbable FFA and MG esters. However, many people taking omega-3 products suffer from hyperlipidemia and thus should avoid a too fatty diet. In this case the omega-3 supplement/drug should be ideally in the FFA-, TG- or rTG-form.

As general rule can be said, that all EPA and/or DHA chemical forms are far better absorbed and thus more bioavailable, if taken together with or shortly after a fatty meal (Figure 6). Thus, bioavailability is directly influenced by (i) the chemical form of the omega-3 fatty acid and (ii) whether this omega-3 fatty acid was ingested in the fasted or fed state."

https://vitalremedymd.com/blogs/professionals/omega-3-bioavailability-dependson-the-chemical-form-concentration-and-fed-state